Unit 11: Mental Illness and Therapies

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Unit 11 Mental Illness and Therapies

• Essential Task 11-2Discuss the major diagnostic
  category of mood disorders with specific
  attention to the diagnoses of major depressive
  disorder, dysthymia, Bipolar I and Bipolar II,
  detail the defining symptoms of each and identify
  the best approach(es) for explaining the
  cause(es) of each.

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We are here
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Mood Disorders - Emotional disturbances that
interfere with normal life functioning (Axis 1)
Bipolar II no mania
Bipolar I
Bipolar disorders
Depressive disorders
Dysthymia
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Major Depressive Episode (building block)

• A. During the same 2-week period, five or more of
  the following symptoms including either 1 or 2
  have been present (must be a change in
  functioning)
• Depressed mood most of the day, nearly everyday
• Diminished interest or pleasure in all, or almost
  all, activities
• Significant changes in appetite and/or weight
• Significant changes in sleep patterns
• Psychomotor retardation or agitation
• Fatigue or loss of energy
• Feelings of worthlessness or inappropriate guilt
• Diminished ability to concentrate or make
  decisions
• Recurrent thoughts or death or suicide

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Major Depressive Episode (building block)

• B. The criteria do not meet criteria for a Mixed
  Episode
• C. The symptoms cause clinically significant
  distress or impairment in functioning
• D. Not due to a General Medical Condition or
  substance
• E. The symptoms are not better accounted for by
  Bereavement

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Manic Episode (building block)

• Distinct period of abnormally and persistently
  elevated, expansive, or irritable mood, lasting
  at least 1 week
• During the mood disturbance, 3 or more of the
  following symptoms have persisted (4 or more if
  the mood is only irritable)
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative than usual, or pressure to keep
  talking
• Racing thoughts (flight of ideas)
• Distractibility
• Increase in goal-directed activity
• Excessive involvement in pleasurable activities
  that have the potential for negative consequences

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Manic Episode (building block)

• C. The symptoms do not meet criteria for a Mixed
  Episode
• D. The symptoms cause significant impairment in
  functioning or necessitate hospitalization to
  prevent harm to self or others
• E. Not due to a GMC or substance

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Mixed Episode (building block)

• A. The criteria are met for both a Manic Episode
  and a Major Depressive Episode (except duration)
  nearly every day during at least a 1-week period
• B. The symptoms cause significant distress or
  impairment in functioning
• C. Not due to a GMC or substance

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Hypomanic Episode(building block)

• Distinct period of persistently elevated,
  expansive, or irritable mood lasting at least 4
  days
• During the mood disturbance, 3 (or more) of the
  following symptoms have been present (4 or more
  if mood is only irritable)
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative than usual, or pressure to keep
  talking
• Racing thoughts (flight of ideas)
• Distractibility
• Increase in goal-directed activity
• Excessive involvement in pleasurable activities
  that have the potential for negative consequences

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Hypomanic Episode(building block)

• C. The episode is associated with an unequivocal
  change in functioning that is uncharacteristic of
  the person when not symptomatic
• D. The mood disturbance and change in functioning
  are observable to others
• E. The episode is not severe enough to cause
  marked distress or impairment in functioning and
  does not require hospitalization
• F. Not due to a GMC or substance

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Mood Episodes
Mixed Episode
Mania
Hypomania
Normal Mood
Depression
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Major Depressive Disorder

• One or more Major Depressive Episodes
• AND
• No history of mania or hypomania
• Specify
• Single Episode
• Recurrent

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Major Depressive Disorder
Major Depressive Episode
Major Depressive Episode
Major Depressive Episode
Major Depressive Episode
MDD, single episode
MDD, recurrent episodes
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Major Depressive Disorder Types

• Melancholic
• Catatonic
• Seasonal Pattern
• Post-partum onset

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Dysthymia

• A. Depressed mood most of the day, more days than
  not, for at least 2 years
• B. Presence, while depressed, of 2 (or more) of
  the following
• 1. Poor appetite or overeating
• 2. Insomnia or hypersomnia
• 3. Low energy or fatigue
• 4. Low self-esteem
• 5. Poor concentration or difficulty making
  decisions
• 6. Feelings of hopelessness
• C. During the 2-year period, the person has never
  been without the symptoms for more than 2 months
  at a time

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Dysthymia

• D. Not better accounted for by Major Depressive
  Disorder
• E. There has never been a Manic, Mixed, or
  Hypomanic episode
• F. Not better accounted for by another disorder
• G. Not due to a GMC or substance
• H. Symptoms cause clinically significant distress
  or impairment in functioning

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Dysthymic Disorder
Dysthymic disorder lies between a blue mood and
major depressive disorder. It is a disorder
characterized by daily depression lasting two
years or more.
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Major Depression vs. Dysthymia
Recurrent Major Depressive Episodes
Dysthymia
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Bipolar Disorder

• Formerly called manic-depressive disorder. An
  alternation between depression and mania signals
  bipolar disorder.

Manic Symptoms
Depressive Symptoms
Elation
Gloomy
Euphoria
Withdrawn
Desire for action
Inability to make decisions
Hyperactive
Tired
Multiple ideas
Slowness of thought
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Bipolar Disorder
Many great writers, poets, and composers suffered
from bipolar disorder. During their manic phase
creativity surged, but not during their depressed
phase.
Earl Theissen/ Hulton Getty Pictures Library
George C. Beresford/ Hulton Getty Pictures Library
The Granger Collection
Bettmann/ Corbis
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Bipolar Disorder

• Two Main Distinctions
• Bipolar I Disorder
• Technically, this should mean Mania/Mixed
  Depression
• Actually, this means Mania/Mixed Depression
• Bipolar II Disorder
• Hypomania /- Depression (No mania ever)
• It is distinguished from Major Depressive
  Disorder by the lifetime history of at last one
  Manic or Mixed Episode

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Bipolar I Disorder
Depressed and manic episodes
One or more manic episode
OR
Major Depressive Episode
Manic or Mixed Episode
Manic or Mixed Episode
OR
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Bipolar II Disorder
One or more hypomanic episode
Depressed and hypomanic episodes
OR
Major Depressive Episode
Hypomanic Episode
Hypomanic Episode
OR
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Unipolar vs. Bipolar Disorder
Elevated Mood
Bipolar
Depressed Mood
Elevated Mood
Unipolar
Depressed Mood
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Explaining Mood Disorders
Since depression is so prevalent worldwide,
investigators want to develop a theory of
depression that will suggest ways to treat it.
Lewinsohn et al., (1985, 1995) note that a theory
of depression should explain the following

1. Behavioral and cognitive changes
2. Common causes of depression

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Theory of Depression

1. Gender differences

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Theory of Depression

1. Depressive episodes self-terminate.
2. Depression is increasing, especially in the teens.

Desiree Navarro/ Getty Images
Post-partum depression
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Mood Disorders
The Etiology of Depression

• Depression often triggered by stress
• However, unlikely that stress alone causes
  depression
• Some people are more vulnerable to depression
  biological vulnerability developmental
  vulnerability

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Biological Perspective
Genetic Influences Mood disorders run in
families. The rate of depression is higher in
identical (50) than fraternal twins (20).
Linkage analysis and association studies link
possible genes and dispositions for depression.
Jerry Irwin Photography
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Neurotransmitters Depression
A reduction of norepinephrine and serotonin has
been found in depression. Drugs that alleviate
mania reduce norepinephrine.
Pre-synaptic Neuron
Serotonin
Norepinephrine
Post-synaptic Neuron
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The Depressed Brain

• PET scans show that brain energy consumption
  rises and falls with manic and depressive
  episodes.

Courtesy of Lewis Baxter an Michael E. Phelps,
UCLA School of Medicine
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Mood Disorders
Psychological Views of Depression
Psychodynamic Views

• Freud noted similarities between grief and
  depression
• Theorized that depression is grief (anger
  sadness) turned against the self
• Actual or symbolic loss can trigger depression
• Attachment theorists have expanded the theory
• Childhood losses/separations create vulnerability
  to later depression

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Mood Disorders
Psychological Views of Depression
Behavioral Views

• When people experience a decline in rewards
  particularly social rewards they can enter a
  downward spiral of decreasing rewards that leads
  to depression.
• Theoretical Problem Does decline in rewards
  cause depression, or does depression cause
  decline in rewards?

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Explanatory Style
Explanatory style plays a major role in becoming
depressed.
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Mood Disorders
Psychological Views of Depression
Cognitive Views

• Depression is the result of ingrained, negative
  thought patterns.
• Two main theories
• Becks Explanatory Style
• Seligmans learned helplessness

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Mood Disorders
Psychological Views of Depression
Cognitive Views

• Negative Thinking
• Maladaptive attitudes often rooted in childhood
• E.g. If I make a mistake, Im worthless
• These attitudes develop into entrenched schemas
• Stress triggers negative schemas

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Mood Disorders
Psychological Views of Depression
Cognitive Views

• Negative Thinking
• Controlled by these schemas, self, present
  future perceived negatively
• Schemas lead to automatic thoughts that
  continuously confirm negative perceptions
• Schemas lead to thinking errors
• E.g. Nobody cares about me

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Mood Disorders
Psychological Views of Depression
Cognitive Views

• Negative Thinking
• Considerable research supports the link between
  depression and
• Maladaptive attitudes negative schemas thinking
  errors automatic thoughts
• However, do cognitive patterns cause depression
  or are they caused by it?

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Systems Approach
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Depression Cycle

1. Negative stressful events.
2. Pessimistic explanatory style.
3. Hopeless depressed state.
4. These hamper the way the individual thinks and
   acts, fueling personal rejection.

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Suicide
The most severe form of behavioral response to
depression is suicide. Each year some 1 million
people commit suicide worldwide.
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Suicide

• Risk Factors
• Best predictor Prior attempt
• Living alone, especially if divorced/separated
• Retired/unemployed
• Elderly
• Loss of a loved one
• Chronic illness
• Financial troubles
• Feelings of hopelessness
• Impulsivity
• Sexual identity difficulties

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Suicide

• Who attempts? Who completes?
• Women 3-4 times more likely to attempt suicide
• Men 3-4 times more likely to complete suicide
• Ages 18-24 Peak age for attempting suicide
• Ages 65 Peak age for completing suicide

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Suicide

• Common Warning Signs
• Symptoms of depression
• Talking about death, disappearing, ending it
  all, etc., even just in passing
• Writing letters, saying last goodbyes
• Getting rid of personal effects, making a will
• Arranging for the care of pets, plants, etc.
• Extravagant spending

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Suicide

• Prevention
• Help the person regain ability to cope with
  immediate stressors
• Maintaining supportive contact with the person
• Help the person realize that their distress is
  impairing their judgment
• Help the person realize that the distress is not
  endless
• Broad based programs focused on high-risk groups
• Crisis hotlines
• Call 911/ER